Ebola is an infectious illness that causes internal bleeding and often proves fatal. It can spread rapidly through contact with small amounts of bodily fluid, and its early flu-like symptoms are not always obvious.

Why is the case in Mbandaka a concern?

Senior WHO official Peter Salama said the spread to Mbandaka meant there was the potential for an “explosive increase” in cases.

“This is a major development in the outbreak,” he told the BBC. “We have urban Ebola, which is a very different animal from rural Ebola. The potential for an explosive increase in cases is now there.”

Mr Salama, the WHO’s deputy director-general for emergency response, said Mbandaka’s location on the River Congo raised the prospect of Ebola spreading to Congo-Brazzaville and the Central African Republic, as well as downstream to Kinshasa, which has a population of 10 million.

“This puts a whole different lens on this outbreak and gives us increased urgency to move very quickly into Mbandaka to stop this new first sign of transmission,” he said.

The 2014-16 West Africa outbreak was the most deadly outbreak of the disease because it spread to the capitals of Guinea, Sierra Leone and Liberia.

Life in the Ebola zone

One teacher in the region told the BBC’s Newsday programme that people had stopped shaking hands when they greet. Ziko Ilema said: “I tried to greet a friend by shaking hands and he said: ‘No, did you forget that Ebola is here?'”

“They forbid people to greet by using hands, eating animals from the forest, and people are now living with fear,” he added.

Ebola is thought to be spread over long distances by fruit bats and is often transmitted to humans eating contaminated bushmeat – meat from wild animals such as monkeys or antelopes.

What is being done to contain the outbreak?

WHO says that of the 45 Ebola cases reported, 14 are confirmed, 21 are probable, and 10 are suspected.

They were recorded in Congo’s Equateur province. Mbandaka is the provincial capital.

Mr Salama said that isolation and rudimentary management facilities had been set up in Mbandaka.

He said the disease could have been taken there by people who attended the funeral of an Ebola victim in Bikoro, south of Mbandaka, before travelling to the city.

On Wednesday more than 4,000 doses of an experimental vaccine sent by the WHO arrived in Kinshasa with another batch expected soon.

These would be given as a priority to people in Mbandaka who had been in contact with those suspected of carrying the Ebola virus before people in any other affected area, Mr Salama said.

The vaccine, from pharmaceutical firm Merck, is unlicensed but was effective in limited trials during the West Africa outbreak.

However, it needs to be stored at a temperature of between -60 and -80 C, which is a challenge in DR Congo because electricity supplies are unreliable.

WHO said health workers had identified 430 people who may have had contact with the disease and were working to trace more than 4,000 contacts of Ebola patients who had spread across north-west DR Congo.

Many of these people were in remote areas, Mr Salama said.

Why does Ebola keep returning?

This is the ninth outbreak of Ebola in DR Congo – it was named after the country’s Ebola river.

Ebola can be introduced into the human population through contact with the blood, organs or other bodily fluids of infected animals. These can include chimpanzees, gorillas, monkeys, antelope and porcupines.

It is not possible to eradicate all the animals who might be a host for Ebola. As long as humans come in contact with them, there is always a possibility that Ebola could return.